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1951, 05-03 Permit App: 5383 Sewage DisposalTO 'd 1W01 - SFUKANE WUN 1 Y HEAL! H UEPAli 1 MEN 1 Division of Sanitation q f g 1127 W. Mallon Avenue 61 - Spokane 11, Washington N? 5383 - DATE_ APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACIUT1ES AddressiCif, hone °Mg ifyg • Site of ...... Maine C•42-4-711, Address of Propos Site. Type of Use-- ..... -,..... Other__ Number of Bedrooms Y Building Capacity Camp Capacity _Other IN property below grade of streets or alleys? Are streets graded in" Is basement for building planned' Water Supply , e11, Spring). Septic tank capacity 10/0 _gals. Style of tank. Length of disposal How Much excavation or fill proposed? (1) Draw in property area to scale, (2) Show relative locatioo of: Proposed house, septic tankiV. disposal field, well, garage, and other out buildings_ r: (a) Make note of any heavy slope or 'swampy area or any X other important topographic details. Date when test hole will be ready for Date installation will be ready for final inspection (that is, before baokfilling) _‘•••• NT` 7 .... 7 .- SANITARIAN'S REPORT AND RECOMMENDATIONS: Topography Ground Water Soil Condition Special Recommendations Date of Inspection_ Percolation tests: Minutes ••••••••••••••.............•••••••••••••••••••• Final Inspection Date Remarks: f RECOMMENDED PERMIT BE_ Sanitarian TRE reiccaov IF ?Lir 61,4-S/TE SEWAr::„F SYSTEM RE'rn.ESET\rrEf) 1.i - (Porn 84G—Hcaltb-2/4,11-.8-6011S Mr To nE ,k4 TO • d 2,66T—TT—HUN